We (*1) take the privacy of your health information seriously. We are
required by law to maintain that privacy and to provide you with this
Notice of Privacy Practices. This Notice is provided to tell you about
our duties and practices.
How we may use and disclose your health information.
The following describe different ways that we use and disclose your health
information without you authorization. Not every use of disclosure in
a category will be listed. However, all the ways we are permitted to use
and disclose information will fall within one of the categories.
*Treatment . We may use health information about you to provide
you with treatment, health care or other related services. We may disclose
your health information with doctors, nurses, aids, technicians or other
staff members of our clinic. Additionally we may disclose and use your
health information to coordinate your treatment .For example, information
obtained by a healthcare provider or staff member will be recorded in
your record and used to determine the best course of treatment. Your records
may be disclosed to Womancare of Southfield, P.C., Womancare of Downriver,
P.C., Womancare of Macomb, P.C., Womancare of Livonia, Womancare of Lansing
and/or Womancare of Flint in order to coordinate your treatment.
*Payment. We may use and disclose your health information to bill
and collect for the treatment and services we provide to you. We may send
your health information to an insurance company or other third party for
payment purposes i.e.: the information on the bill may include information
that identifies you as well as your diagnosis, procedure and supplies
used.
*Regular Healthcare Operations. For example members of the medical
staff may use information in your health record to asses the care you
received and outcomes of your care.
*As required by law. We will disclose your health information
when we are required to do so by federal, state or local law. For example
in response to a valid subpoena.
*For Public Health purposes:
-preventing or controlling disease, injury
or disability
-reporting birth and deaths;
-reporting defective medical devices or problems with medications
-notifying people of recalls of products they may be using
-notifying a person who may have been
exposed to a disease or may be at risk for contracting or spreading a disease
or condition.
Other uses and disclosures of health information not covered by this
notice or the laws that apply to us will be made only with your written
authorization. If you provide us authorization to use or disclose your
health information, you may revoke that authorization, in writing, at
any time. If you revoke your authorization, we will no longer use or disclose
health information about you for the reasons covered by your written authorization.
You understand that we are unable to take back any disclosures we have
already made under the authorization, and that we are required to retain
our records of the care that we provided to you.
Your Health Information rights.
_Request a restriction on certain uses and disclosures of your information.
We are not required to agree to your request, If we do agree; we will
comply with your request unless the information is needed to provide you
emergency treatment.
_Obtain a paper copy of the notice of information practices upon request.
_Inspect a copy of your health records
_Amend your health records as provided in 45 CFR 164.528.
_Obtain a list of disclosures of your health information.
_Request communication of your health information by alternative means
or at alternative locations.
_Revoke you authorization to use or disclose health information except
to the extent that action has already been taken.
Our responsibility.
-Maintain the privacy of your health information.
-Provide you with a notice as to our legal duties and privacy practices
with respect to information we collect and maintain about you.
-Abide by the terms of this notice
-Notify you if we are unable to agree to a requested restriction.
-Accommodate reasonable requests you may have to communicate health information
by alternative means or at alternative locations
We reserve the right to change this Privacy Notice and to make the revised
notice effective for health information we already have about you as well
as any information we receive in the future.
We will post a copy of the current Privacy Notice in a clear location
to which you have access. The notice will be available upon request
For more information or to file a complaint contact our Privacy Officer at 248-443-0239 or mail your letter to:
Womancare of Southfield
Privacy Department
28505 Southfield RD
Lathrup Village, MI 48076